MLP Prop Form Design
Who can use this proposal form: This proposal form is only for UK Private Limited Companies and Non-Listed PLC’s, LLP’s, Partnerships, and Sole Traders.
This proposal form must be completed and signed by a Principal, Partner or Director of the Proposer/s. The person completing and signing the proposal form should be authorised by the Proposer/s to do so and should make all necessary enquiries of his fellow Partners, Directors and Employees to enable all the questions to be answered.
All questions must be answered to enable a quotation to be given.
Completing and signing this proposal form does not bind the Proposer/s or Jensten Insurance Brokers to enter a contract of insurance.
If there is insufficient space to answer questions, please use an additional sheet and attach it to this form (please indicate section number).
A copy of this proposal form should be retained by you for your own records.
Are you a Financial Institution, Investment Management or Bank?
Does your business operate in the following sectors: Professional Sports Clubs or Regulatory Bodies, Payment Processesors (as main activity), Coal Mining, Oil Production or Exploration, Nuclear or Weapons related, Animal Testing, Tabacco Manufacturing, Logging in World Heritage sites?
Is your business a Public Limited Company (PLC)?
Are you in profit or predicting profit for the next 36 months?
Do you require cover for assets in the USA?
Do you require cover for turnover coming from the USA where it forms more than 40% of overall turnover?
Do you obtain external HR/Legal advice for dismissals or register for referral to rradar?
Are all duties segregated so that dual control exist on all payments; reconciliation of payroll, customer and bank account statements?
Is your business involved in the education or care sector?
Are you involved in the supervision of children or vulnerable adults?
Do you provide any financial or legal advice?
Have you made any redundancies in the last six months?
Do you plan to make any redundancies or close any operations in the next 12 months?
In the last five (5) years, have there been any claims or investigations made against you, or against any directors, trustees, officers or employees, that this policy might have covered if it had been in force?
After full enquiry, are you or any of your directors, trustees, human resource managers, risk managers, or insurance managers aware of any fact or circumstance that may lead to a claim under the proposed insurance policy?
Your Premium Indication excludes taxes and fees
Flex your levels of cover
| Directors's and Officers' Liability | Company Legal Liability | Employment Practices Liability | |
| Cover level selected |
IMPORTANT!
The Premium indication excludes taxes and fees. Your cover will only start when Jensten Underwriters Limited accepts your proposal. Your Jensten Insurance Brokers will confirm cover with you.
You can speak to your adviser about flexible options for your cover limits. In some cases, reducing the level of cover in one area can reduce your overall premium. Please speak to your adviser to find our more.
We can't provide you with a Premium indication right now your answer(s) require us to review your proposal form. Please complete this form and send your proposal to your Jensten contact, and they'll refer you to Underwriters.
If you have not given full and true answers to all questions asked on this proposal form, your insurance may not protect you in the event of a claim.
Jensten Underwriting Limited is part of the Jensten Group of companies which takes your privacy very seriously. For details of how we use the personal information we collect from you and your rights please view our privacy policy at https://jensteninsurance.co.uk/privacy-notice. If you do not have access to the internet please contact us and we will send you a printed copy.
Please read this declaration carefully and then sign below
- I/W e understand that all relevant information , which is information that may influence AXA Insurance UK plc in the acceptance of this insurance and the terms provided, has been disclosed and recorded
- I/We declare that all particulars given in this proposal form whether made by me/us or on my/our behalf are true and complete.
- I/We understand that if full and true answers have not been given or if all relevant information has not been disclosed that this insurance may not protect me/us in the event of a claim.
- I/We will tell you of any change to the details given before the start date of the contract.
Date:
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